Healthcare Provider Details

I. General information

NPI: 1043764384
Provider Name (Legal Business Name): RANDEE MCLAIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE O
SANTEE CA
92071
US

IV. Provider business mailing address

9445 FARNHAM ST
SAN DIEGO CA
92123-1308
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax:
Mailing address:
  • Phone: 858-636-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number82351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: